Patty: I don't recall a time in recent history that has been more challenging for HIM leaders. They are faced with the uncertainty about the potential impact of health care reform on health care organizations, unemployment-which is still predicted to rise as a result of the recession-and the transformation of health information through wide-spread adoption of EHRs.

Leslie: Yes, we are indeed living through an anxious time, which is one reason that Katharine Gratwick Baker, PhD, and I have just finished writing a new book on leadership, Leading a Business in Anxious Times: A Systems Approach to Becoming More Effective in the Workplace. In this book we explain Systems-Based Leadership™, an approach that addresses the emotional side of organizations and the impact that increased anxiety has on their success.

Patty: I understand that leadership is more important than ever but why another book on leadership? If you Google leadership, millions of results are returned for books and articles on leadership.

Leslie: Yes, leadership is widely studied, written about, taught and debated. However, the emotional side of organizations, or the emotional system to be more precise, has been largely overlooked; examining leadership in the context of the organization as an emotional system provides a perspective that can affect how we think about leading and how we engage our colleagues in the workplace.

Patty: Let's ask your co-author, Dr. Baker, to join our discussion to further explore the uniqueness of systems-based leadership. Her experience as a business consultant and executive coach to HIM and other professionals was instrumental in bringing to life the stories of seven business leaders included in the book.

Leslie: Katharine, please tell our readers more about systems-based leadership.

Katharine: During the years that I have coached HIM professionals, I have come to respect enormously the contributions they are making to the transformation of our health care system. I also understand how difficult it can be for them to have their voices heard above the din of anxiety that permeates many health care institutions today. In Leading a Business in Anxious Times, we demonstrate how the ability to be a leader in the workplace is directly related to the capacity to think clearly and take thoughtful action in the presence of anxious colleagues.

Leslie: Leaders with greater self-awareness, as well as an awareness of the larger emotional system of the workplace, can learn to define their positions on important issues in a way that is heard and processed by others in a meaningful way.

Katharine: Systems-based leadership is a way of leading that takes into account the impact of anxiety on judgment and performance throughout the organization, and how anxiety affects organizational outcomes and success. Practitioners of systems-based leadership focus on managing their own anxiety and being cognizant of the patterns of behavior among their co-workers. An observant systems-based leader sees beyond the behavior of an individual or a two-person relationship and maintains a broader view of the emotional dynamics in a department, unit or the entire organization.

Leslie: This calmer and broader perspective yields more options for taking thoughtful action in the midst of tense or even chaotic situations.

Katharine: Systems-based leadership offers a way to look at the organization as a whole and not just as a collection of individuals who happen to work together. A workplace is a living system, one in which the individual members are mutually interdependent, thereby responding to stress as a single unit. Each work system has a unique history in which patterns of automatic behavior have evolved over time. When anxiety in the organization is high, the automatic patterns of behavior kick in, unless it has emotionally mature individuals who can calm things down, see the fuller range of options and generate more thoughtful action.

Leslie: The transition to EHRs is creating profound change. Work flow and work processes are changing for everyone from clinicians who have to change habits of a lifetime to create and use medical records, to HIM staff who must develop new processes for assuring completeness, accuracy, privacy and authorized access to the EHR, to quality management professionals who must use the EHR to collect, evaluate and report on medical outcomes. So much change creates stress that often results in more reactive behavior and poorer functioning. Competent, dedicated people may make more mistakes, have more conflicts, shut down or get sick. In highly anxious organizations, turnover increases, profitability decreases and morale is generally characterized as apathetic or poor.

Katharine: We believe that people who anticipate reactivity to change, and learn not to get caught up in that reactivity can provide mature leadership during anxious times. The ability to keep thinking in the presence of anxious co-workers, to take non-reactive positions on difficult issues, and to tolerate reactivity in others while guiding them to become more thoughtful, will eventually calm the organization and enable a higher level of functioning. That is the essence of systems-based leadership.

Patty: What are some of the principles of systems-based leadership discussed in the book?

Katharine: One of the unique principles is to be aware of your own anxious behavior patterns and explore how those patterns evolved in the family in which you grew up. Reflecting on the relationship between how you function in the family you grew up in and how you function at work can provide insights and often a new appreciation for the profound impact of anxiety in all areas of your life.

Leslie: Another key principle is to stay in touch with co-workers in the work system even when you are feeling anxious yourself. Learning to overcome the urge to distance from colleagues during anxious times reduces the contagiousness of anxiety and enables people to think more creatively.

Katharine: One more key principle-take nonreactive, clearly conceived and clearly defined positions on important issues. Taking an "I" position means you draw on your values and beliefs, as well as objective facts, to state your position on an issue in as emotionally neutral a way as possible. HIM professionals must be able to calmly and clearly articulate their position in a way that can be heard by anxious colleagues.

Patty: We have come to the end of our column for the month but let's continue to explore systems-based leadership in future columns.

Leslie: That sounds like a good plan. Katharine and I will also be attending the American Health Information Management Association national convention and exhibit in Grapevine, TX, and look forward to the opportunity to talk with readers about systems-based leadership.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.